Observation direct referral from physician office for admission at WellSpan Ephrata Community Hospital
169 Martin Ave, Ephrata, PA · Wellspan · · NPI 1083615587
$596.80
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$746.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$131.30 with Blue_Cross_BlueJourney_Medicare vs $2,715.33 with Highmark — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| Blue_Cross_BlueJourney_Medicare | All_Plans | $131.30 | ↓ -78% |
| Aetna | All_Plans | $194.00 | ↓ -67% |
| First_Health_Network | All_Plans | $206.00 | ↓ -65% |
| Blue_Cross | Capital_Cares_4_kids | $336.19 | ↓ -44% |
| Cigna | All_Plans | $454.16 | ↓ -24% |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $459.83 | ↓ -23% |
| WellSpan_Capital_Blue_Cross | All_Plans | $477.44 | ↓ -20% |
| Blue_Cross | All_Other_Plans | $480.27 | ↓ -20% |
| Blue_Cross | Capital_Blue_Performance_PPO | $480.27 | ↓ -20% |
| Geisinger | All_Plans | $484.90 | ↓ -19% |
| UPMC | UPMC_For_Kids | $484.90 | ↓ -19% |
| UPMC | Employees_And_Dependents | $484.90 | ↓ -19% |
| Independence_Blue_Cross | All_Plans | $484.90 | ↓ -19% |
| Tower Health | All_Plans | $484.90 | ↓ -19% |
| PHC | All_Plans | $522.20 | ↓ -13% |
| Health_Partners_Medicaid | All_Other_Plans | $592.13 | ↓ -1% |
| Highmark_Medicare | All_Plans | $598.05 | ↑ +0% |
| Aetna_Advantra_Medicare | All_Plans | $609.89 | ↑ +2% |
| Aetna_Medicare | All_Plans | $609.89 | ↑ +2% |
| Devoted_Medicare | All_Plans | $621.74 | ↑ +4% |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $621.74 | ↑ +4% |
| Geisinger_Gold_Medicare | All_Plans | $621.74 | ↑ +4% |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $621.74 | ↑ +4% |
| United_Medicare | ISNP_DSNP_Plans | $621.74 | ↑ +4% |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $624.40 | ↑ +5% |
| Amerihealth_Medicare | All_Plans | $624.70 | ↑ +5% |
| Jefferson_Health_Medicare_Advantage | All_Plans | $639.50 | ↑ +7% |
| PA_Health_&_Wellness_Medicare | All_Plans | $639.50 | ↑ +7% |
| United_Healthcare | All_Plans | $703.48 | ↑ +18% |
| Highmark | Higmark_Healthy_Kids | $919.28 | ↑ +54% |
| Health_Partners_Medicaid | Kidz_Partners | $977.01 | ↑ +64% |
| United_Medicaid | Community_Plan_For_Kids | $1,036.23 | ↑ +74% |
| Geisinger_Medicaid | All_Plans | $1,500.00 | ↑ +151% |
| UPMC_Medicaid | All_Plans | $1,500.00 | ↑ +151% |
| Highmark | My_Direct_Blue | $2,172.29 | ↑ +264% |
| Highmark | My_Priority_Blue_Flex | $2,172.29 | ↑ +264% |
| Highmark | Blue_Cross_High_Performance_Network | $2,253.71 | ↑ +278% |
| Highmark | Performance_Blue | $2,253.71 | ↑ +278% |
| Highmark | Choice_Blue_PPO | $2,253.71 | ↑ +278% |
| Highmark | All_Other_Plans | $2,715.33 | ↑ +355% |
Visitor-reported prices
Comments
Observation direct referral from physician office for admission at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $117.00 | $27.00 – $2,064.00 |
| UPMC Bedford | Everett | $166.20 | $31.88 – $2,207.16 |
| UPMC Carlisle | Carlisle | $420.00 | $95.90 – $2,064.00 |
| UPMC Cole | Coudersport | $84.00 | $38.81 – $112.00 |
| UPMC Community Osteopathic | Harrisburg | $420.00 | $169.40 – $3,000.00 |
| UPMC East | Monroeville | $130.20 | $31.88 – $2,207.16 |
| UPMC Hamot | Erie | $138.60 | $674.61 – $728.58 |
| UPMC Northwest | Seneca | $112.80 | $31.88 – $631.28 |